| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
INSERM U 289 and Fédération de Neurologie (Drs. Vidailhet, Bonnet, and Agid), Hôpital de la Salpêtrière, Paris, France; Neurological Institute Sanatrix (Dr. Marconi), Pozzilli, Italy; and Institut de Neurologie (Dr. Gouider-Khouja), Tunis, Tunisia.
Parkinsonian symptoms and levodopa-induced dyskinesias (LIDs) are often considered to occur first, and to predominate, in the upper limbs. We studied the topography, type, sequence, and severity of LIDs in 20 consecutive patients with Parkinson's disease (PD) experiencing LIDs for less than 6 months (Hoehn and Yahr stage II-III; average age at onset of PD, 57 years; average duration of PD, 7.2 years; percent of improvement with levodopa >50) and compared them with the initial site, form, and evolution of the patient's motor disability. Parkinsonism started in the foot in six of 20 patients. Motor disability in the "off" state was similar in upper and lower extremities, except for akinesia, which was worse in the lower limbs. A careful interview indicated that LIDs had started in the foot in all patients. After administration of a single dose of levodopa ("levodopa test"), LIDs appeared in all patients as dystonia of the foot homolateral to the side most affected by PD (onset-of-dose dyskinesia). LIDs were preceded by "off" dystonia (dystonic foot) in six patients and were followed by mid-dose dyskinesia in eight. This is consistent with an early loss of dopaminergic innervation corresponding somatotopically to the foot area. The similarities among initial LIDs, early morning dystonia, and onset-of-dose dyskinesia suggest a similar pathophysiology.
Address correspondence and reprint requests to Dr. Marie Vidailhet, INSERM U 289, Hôpital de la Salpêtrière, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
Supported by INSERM (France). Dr. Marconi is the recipient of a CNR (Italy) grant.
Received December 30, 1993. Accepted in final form February 23, 1994.
This article has been cited by other articles:
|
|
 |
|
  S. Mounayar, S. Boulet, D. Tande, C. Jan, M. Pessiglione, E. C. Hirsch, J. Feger, M. Savasta, C. Francois, and L. Tremblay A new model to study compensatory mechanisms in MPTP-treated monkeys exhibiting recovery Brain, November 1, 2007; 130(11): 2898 - 2914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. de la Fuente-Fernandez, V. Sossi, Z. Huang, S. Furtado, J.-Q. Lu, D. B. Calne, T. J. Ruth, and A. J. Stoessl Levodopa-induced changes in synaptic dopamine levels increase with progression of Parkinson's disease: implications for dyskinesias Brain, December 1, 2004; 127(12): 2747 - 2754. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Jankovic Levodopa strengths and weaknesses Neurology, February 1, 2002; 58(90001): S19 - 32. [Abstract] [Full Text]
|
|
|
|
|
|
C. H. Adler Relevance of motor complications in Parkinson's disease Neurology, February 1, 2002; 58(90001): S51 - 56. [Abstract] [Full Text]
|
|
|
|
 |
|
 E. Cubo, J.-M. Gracies, R. Benabou, C. W. Olanow, R. Raman, S. Leurgans, and C. G. Goetz Early Morning Off-Medication Dyskinesias, Dystonia, and Choreic Subtypes Arch Neurol, September 1, 2001; 58(9): 1379 - 1382. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Damier, E. C. Hirsch, Y. Agid, and A. M. Graybiel The substantia nigra of the human brain: II. Patterns of loss of dopamine-containing neurons in Parkinson's disease Brain, August 1, 1999; 122(8): 1437 - 1448. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
